Watching the Republican presidential candidates and their agitated tea party supporters at the CNN/Tea Party debate, an ordinary citizen might feel confused. Those people sound angry, but exactly what do they believe our government should (and shouldn't) do on behalf of its citizens?

Ensuring affordable health care for everyone seemed to be on the forbidden list, even for Mitt Romney, who had tried to do exactly that as governor of Massachusetts. Every one of the candidates vehemently insisted, with predictably enthusiastic applause, that President Obama's health care reform must go, immediately, if not sooner. And just as predictably, none of them suggested how to provide affordable health care to the roughly 50 million Americans who lack coverage -- a number that reached a new record last month.

Indeed, when CNN anchor Wolf Blitzer asked whether a young man lacking private health insurance should simply be allowed to die if he suddenly suffered an accident or illness, some audience members screamed "yes!" Many of the rest cheered, while the would-be presidents stood by woodenly, without the dignity of a demurral.

It was a revealing moment that may foretell a new and meaner Republican platform: If you lose your job and your health care, don't expect any help, except perhaps from the church. And if your innocent kids get sick, too bad for them. Forget about Medicare, Medicaid and any American who can't afford private insurance. This is a free country -- so don't get sick.

"That's what freedom is all about -- taking your own risks," said Ron Paul (a medical doctor who doesn't apply the Hippocratic oath to his congressional service) in answering Blitzer. "This whole idea that you have to take care of everybody ..." he went on disdainfully, before the audience cut him off with shrieks and applause.

Yet during the same debate, Rick Perry, the GOP's leading contender, justified his program to inoculate young schoolgirls against cervical cancer by explaining that he was putting life first, as always -- and then boasted about the millions of state dollars he has spent seeking a cure for cancer. While all the other candidates attacked the Texas governor for his Gardasil vaccination program, what bothered them more than the state funding was the alleged lack of parental consent. In principle, most of them seemed to think that state-funded protection for children against a deadly disease might even be acceptable.

Perry himself wasn't exactly clear on this topic, either, since he has denounced Medicare as unconstitutional. He took umbrage at Michele Bachmann's suggestion that a $5,000 donation from the vaccine's distributor had influenced his decision -- but he actually took at least five times that amount, so perhaps Texas is just a place where legal bribes, like everything else, are bigger.

For anyone trying to understand what Republicans think about government's role in health care, however, the debate displayed a puzzling level of incoherence. Is vaccinating schoolchildren a state function? Should taxpayers fund a cure for cancer? And why should government at the state or federal level assume responsibility for those needs, while ignoring millions of families and individuals without health insurance?

These are not academic questions, even for right-wing ideologues. Within hours after the debate concluded, the Gawker website revisited the sad story of Kent Snyder, the late libertarian activist behind the Ron Paul presidential industry, who died three years ago from complications of pneumonia. It was Snyder who pushed Paul into the presidential sweepstakes that have brought him millions of dollars and landed his dim son Rand Paul in the United States Senate.

Snyder died without insurance -- which his sister said was unaffordable to him because of a pre-existing medical condition -- and left $400,000 in hospital bills for his mother. Whether the Paul family did anything to help the Snyder family isn't clear, but other friends were driven to take up an Internet collection to help defray the costs.

Lack of insurance -- and the lack of adequate insurance -- present a daily concern for increasing numbers of Americans. According to the Census Bureau, the exact number has reached 49.9 million, the highest number since the advent of Medicare and Medicaid and the highest percentage of uninsured Americans since the recession of 1976.

The consequences are tragic and -- although financially costly to American society compared with other advanced countries -- go far beyond mere money. Being uninsured means foregoing necessary care, especially preventive care, which annually causes the premature deaths of at least 50,000 people.

The Republicans up on that debate stage and the tea party claque don't think this is their problem. They don't care. They must be the only Christians in the world who would cheer wildly at the idea of someone dying from lack of health insurance. And they will nevertheless vote for the Texan who spent millions of state dollars vaccinating those little girls. Is it the fury and the bile that kills brain cells?

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